SB1553 EngrossedLRB097 09436 RPM 49571 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 359c as follows:
 
6    (215 ILCS 5/359c)
7    Sec. 359c. Accident and health expense reporting.
8    (a) Beginning January 1, 2011 and every 6 months
9thereafter, any carrier providing a group or individual major
10medical policy of accident or health insurance shall prepare
11and provide to the Department of Insurance a statement of the
12aggregate administrative expenses of the carrier, based on the
13premiums earned in the immediately preceding calendar year
146-month period on the accident or health insurance business of
15the carrier. The annual semi-annual statements shall be filed
16on or before April 1 July 31 for the preceding calendar year
176-month period ending June 30 and on or before February 1 for
18the preceding 6-month period ending December 31. The statements
19shall itemize and separately detail all of the following
20information with respect to the carrier's accident or health
21insurance business:
22        (1) the amount of premiums earned by the carrier both
23    before and after any costs related to the carrier's

 

 

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1    purchase of reinsurance coverage;
2        (2) the total amount of claims for losses paid by the
3    carrier both before and after any reimbursement from
4    reinsurance coverage including any costs incurred related
5    to:
6            (A) disease, case, or chronic care management
7        programs;
8            (B) wellness and health education programs;
9            (C) fraud prevention;
10            (D) maintaining provider networks and provider
11        credentialing;
12            (E) health information technology for personal
13        electronic health records; and
14            (F) utilization review and utilization management;
15        (3) the amount of any losses incurred by the carrier
16    but not reported to the carrier in the current or prior
17    reporting period;
18        (4) the amount of costs incurred by the carrier for
19    State fees and federal and State taxes including:
20            (A) any high risk pool and guaranty fund
21        assessments levied on the carrier by the State; and
22            (B) any regulatory compliance costs including
23        State fees for form and rate filings, licensures,
24        market conduct exams, and financial reports;
25        (5) the amount of costs incurred by the carrier for
26    reinsurance coverage;

 

 

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1        (6) the amount of costs incurred by the carrier that
2    are related to the carrier's payment of marketing expenses
3    including commissions; and
4        (7) any other administrative expenses incurred by the
5    carrier.
6    (b) The information provided pursuant to subsection (a) of
7this Section shall be separately aggregated for the following
8lines of major medical insurance:
9        (1) individually underwritten;
10        (2) groups of 2 to 25 members;
11        (3) groups of 26 to 50 members;
12        (4) groups of 51 or more members.
13    (c) The Department shall make the submitted information
14publicly available on the Department's website or such other
15media as appropriate in a form useful for consumers.
16(Source: P.A. 96-857, eff. 1-5-10.)
 
17    Section 99. Effective date. This Act takes effect upon
18becoming law.